Provider Demographics
NPI:1225185127
Name:NWOKU, ADA JACSIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:JACSIN
Last Name:NWOKU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ADA
Other - Middle Name:JACSIN
Other - Last Name:NSOFOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:700 KING SWORD CT SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-6437
Mailing Address - Country:US
Mailing Address - Phone:678-522-5389
Mailing Address - Fax:
Practice Address - Street 1:5041 DALLAS HWY
Practice Address - Street 2:BUILDING 2, SUITE C
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-6458
Practice Address - Country:US
Practice Address - Phone:678-522-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0133761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice